The General Medical Council v Dr Ali Shokouh-Amiri

On an appeal under section 40A of the Medical Act 1983, the court reviews whether a tribunal’s relevant decision was wrong or unjust because of a serious procedural irregularity. Intervention remains exceptional on primary facts, but is justified where the tribunal fails to address a central issue, gives unintelligible reasons, or reaches a conclusion out of tune with the evidence. Fitness to practise is not confined to future repetition risk: public confidence and proper professional standards are also relevant. Here, findings concerning one patient’s ureteric injury and another patient’s alleged conduct were quashed. The cross-admissibility and impairment grounds otherwise failed.

The General Medical Council appealed under section 40A of the Medical Act 1983 from a Medical Practitioners Tribunal determination dated 14 February 2025. The Tribunal had found some misconduct but concluded that Dr Ali Shokouh-Amiri’s fitness to practise was not impaired and made no direction, although it issued a warning. The appeal challenged findings concerning Patients B and F, the Tribunal’s approach to cross-admissibility, and its conclusion on impairment. The central questions were whether the Tribunal’s relevant decision was wrong or unjust because of serious procedural or other irregularity, and what order should follow.

The court allowed Grounds 1 and 2 and dismissed Grounds 3 and 4.

1. Appellate approach. An appeal under section 40A of the Medical Act 1983 is by way of review. The court asks whether the relevant Tribunal decision was wrong or unjust because of a serious procedural or other irregularity. Primary factual findings attract substantial deference, but less deference is required for inferential facts and evaluative judgments. Intervention is justified for an error of principle or a conclusion outside the range reasonably open to the Tribunal.
2. Reasons. Under Rule 17 of the General Medical Council (Fitness to Practise) Rules 2004, reasons must be proper, adequate and intelligible, address substantial points, and disclose no reasoning error. The court may examine the underlying material to understand the decision, but may not speculate about the Tribunal’s reasoning or reconstruct a result it might have reached.
3. Patients B and F. The Tribunal failed to resolve the central evidential issue concerning Patient B’s presentation shortly after surgery and did not engage with the expert evidence. Its reasoning was also circular. In relation to Patient F, it made factual errors, failed to assess her detailed and consistent evidence, and gave inadequate reasons for rejecting it. The relevant findings were therefore wrong and/or unjust because of serious procedural irregularity.
4. Cross-admissibility. The court applied the distinction between propensity and rebuttal of coincidence, including the need to consider collusion or contamination. The Tribunal breached rule 6(b) of the General Medical Council (Legal Assessors and Legally Qualified Persons) Rules 2015 by failing to include new legal advice in its decision. Nevertheless, the breach caused no injustice. The Tribunal was not required to give a coincidence direction in the circumstances, and the unchallenged weaknesses in the cases concerning Patients A and D meant that remittal would be inappropriate. Ground 3 failed.
5. Impairment and order. Public confidence and proper professional standards remain relevant to impairment, even where future repetition risk is low. The Tribunal’s conclusion on impairment was nevertheless within the range reasonably open to it. Ground 4 failed. The relevant decision, including the finding of no impairment and the decision not to make a direction, was quashed. The case was to be remitted to a differently constituted tribunal to reconsider the specified allegations and impairment.

1. High Court (Administrative Court): Appeal under section 40A of the Medical Act 1983. Grounds 1 and 2 succeeded; Grounds 3 and 4 failed. The Tribunal’s relevant decision was quashed and the case was to be remitted to a differently constituted tribunal.
2. Medical Practitioners Tribunal: Determination dated 14 February 2025. Some misconduct was found, but fitness to practise was held not impaired and no direction was made; a warning was issued under section 35D(3) of the Medical Act 1983.